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Colon screening questioned

Yale Medicine Magazine, 2008 - Spring


Colorectal cancer screenings for the severely ill may do more harm than good, according to a Yale study published in the Archives of Internal Medicine in November.

This finding resulted from a new method of evaluating medical tests that gauges “payoff time”—how long it takes for a test’s benefits to outweigh complications and side effects. Researchers led by R. Scott Braithwaite, M.D., assistant professor of medicine, studied 50-year-old men with HIV and 60-year-old women with severe congestive heart failure.

The payoff time for the screenings was up to five years for the men and 2.9 years for the women. But patients with severe congestive heart failure were less likely to benefit—they have a life expectancy of less than 2.9 years. Patients with HIV, however, have a life expectancy of more than five years.

“This issue is becoming increasingly important as pay-for-performance and physician ‘report cards’ encourage clinicians to offer screening to everyone, regardless of individual benefit,” said Braithwaite.

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